Provider Demographics
NPI:1053497289
Name:NORTHWOODS FAMILY DENTAL SC
Entity Type:Organization
Organization Name:NORTHWOODS FAMILY DENTAL SC
Other - Org Name:MARY C PADGETT DDS
Other - Org Type:Other Name
Authorized Official - Title/Position:DDS
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:C
Authorized Official - Last Name:PADGETT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:715-365-6859
Mailing Address - Street 1:922 MARGARET STREET
Mailing Address - Street 2:
Mailing Address - City:RHINELANDER
Mailing Address - State:WI
Mailing Address - Zip Code:54501-3835
Mailing Address - Country:US
Mailing Address - Phone:715-365-6859
Mailing Address - Fax:715-362-7060
Practice Address - Street 1:922 MARGARET STREET
Practice Address - Street 2:
Practice Address - City:RHINELANDER
Practice Address - State:WI
Practice Address - Zip Code:54501-3835
Practice Address - Country:US
Practice Address - Phone:715-365-6859
Practice Address - Fax:715-362-7060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33769700Medicaid